Health
Experts recommend additional cholesterol levels
Patients with high levels of “bad” (LDL) cholesterol (70 mg / dl and above), who are also at high risk of heart disease, should be given additional cholesterol-lowering drugs BMJ today.
The drugs evaluated by the panel are ezetimibe and PCSK9 inhibitors. They work by reducing the absorption of cholesterol from foods and the production of cholesterol in the body.
The recommendations apply to adults who are already taking the highest dose of statins, or adults who are intolerant to statins and are part of the BMJ’s “Rapid Recommendation” initiative-physicians make better decisions with patients. Create quick and reliable guidance based on new evidence to help you make the decision.
The panel considers the balance between the burden of starting a new drug and the benefits of potential harm, depending on the patient’s risk, values, and level of preference, and their advice focuses on lowering cholesterol levels. From the traditional focus of focus, the individual’s overall cardiovascular risk.
New evidence from 14 trials in 83,660 patients is that ezetimib and PCSK9 inhibitors probably reduce heart attack and stroke in patients with very high and high cardiovascular risk, but moderately. It has been shown to not reduce in patients with low cardiovascular risk.
These relative benefits were consistent, but their absolute magnitude varied based on the cardiovascular risk of individual patients (eg, treated with statins plus PCSK9 inhibitors for 5 years). For only 1000 people, the benefits ranged from 2 reductions to 21 reductions in stroke at the lowest risk (highest risk).
No significant secondary events were found, but PCSK9 inhibitors require injections and may cause injection site reactions. Experts say this is a significant burden and harm to the patient.
PCSK9 inhibitors are more expensive than ezetimibe and statins.
As such, the panel favors ezetimibe over PCSK9 inhibitors, but “both have significant benefits for adults in the high-risk and very high-risk groups, but mostly for adults in the low-risk group. There is no such thing. “
The Panel acknowledges some uncertainty in the evidence underlying this guideline and notes that clinicians need to identify individual cardiovascular risks in patients in order to apply these risk stratification recommendations. To do.
And they say their recommendations may change as new evidence emerges.
[Ends]
Attention to editors
Rapid Recommendations: PCSK9 Inhibitors and Ezetimibe for Reducing Cardiovascular Events: Clinical Practice Guidelines with Risk Group Recommendations
journal: BMJ
Survey method
Systematic review
Research target
people
Article title
PCSK9 Inhibitors and Ezetimibe for Reducing Cardiovascular Events: Clinical Practice Guidelines with Risk Group Recommendations
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